Retroperitoneal Hemorrhage

Epidemiology

Risk Factors


Etiology

Coagulopathy

Acquired Vitamin K Deficiency (see Vitamin K, [[Vitamin K]])

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Anticoagulation

  • General Comments: incidence is 0.6-6.6% in the setting of therapeutic anticoagulation
  • Coumadin (see Coumadin, [[Coumadin]])
  • Factor IIa (Thrombin) Inhibitors (see Factor IIa Inhibitors, [[Factor IIa Inhibitors]])
    • Argatroban (Acova) (see Argatroban, [[Argatroban]])
    • Bivalirudin (Angiomax, Angiox) (see Bivalirudin, [[Bivalirudin]])
    • Dabigatran (Pradaxa) (see Dabigatran, [[Dabigatran]])
    • Desirudin (Iprivask, Revasc) (see Desirudin, [[Desirudin]])
    • Lepirudin (Refludan (see Lepirudin, [[Lepirudin]])
  • Factor Xa Inhibitors (see Factor Xa Inhibitors, [[Factor Xa Inhibitors]])
    • Apixaban (Eliquis) (see Apixaban, [[Apixaban]])
    • Betrixaban
    • Danaparoid (Orgaran) (see Danaparoid, [[Danaparoid]])
    • Edoxaban (Lixiana) (see Edoxaban, [[Edoxaban]])
    • Fondaparinux (Arixtra (see Fondaparinux, [[Fondaparinux]])
    • Rivaroxaban (Xarelto) (see Rivaroxaban, [[Rivaroxaban]])
  • Heparins
    • Dalteparin (Fragmin) (see Dalteparin, [[Dalteparin]])
    • Enoxaparin (Lovenox) (see Enoxaparin, [[Enoxaparin]])
    • Heparin (Unfractionated) (see Heparin, [[Heparin]])

Antiplatelet Agents

Coagulopathic Conditions

IIb/IIIa Inhibitors (see IIb IIIa Inhibitors, [[IIb IIIa Inhibitors]])

  • Abciximab (ReoPro) (see Abciximab, [[Abciximab]])
  • Eptifibatide (Integrilin) (see Eptifibatide, [[Eptifibatide]])
  • Tirofiban (Aggrastat) (see Tirofiban, [[Tirofiban]])

Thrombocytopenia (see Thrombocytopenia, [[Thrombocytopenia]])

Thrombolytics (see Thrombolytics, [[Thrombolytics]])

Iatrogenic

  • Femoral Arterial Puncture
    • Cardiac Catheterization: incidence is 0.15%
  • Femoral Venous Puncture
    • Central Venous Catheter Placement
  • Renal Biopsy
  • Trans-Lumbar Aortography

Other

  • Hemorrhage from Adrenal Cyst
  • Rupture of Abdominal Aortic Aneurysm (AAA) (see Abdominal Aortic Aneurysm, [[Abdominal Aortic Aneurysm]])
  • Rupture of Left Inferior Phrenic Artery
  • Trauma
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Disgnosis

  • Abdominal Ultrasound: may be diagnostic
  • Abdominal/Pelvic CT without Contrast: diagnostic

Clinical Manifestations

Cardiovascular Manifestations

Gastrointestinal Manifestations

  • Abdominal Compartment Syndrome (see Abdominal Compartment Syndrome, [[Abdominal Compartment Syndrome]]): may occur in cases with severe retroperitoneal hemorrhage

Other Manifestations

  • Back Pain (see Back Pain, [[Back Pain]])
  • Femoral/Lumbar Plexus Compressive Neuropathy: may present with lower extremity pain/sensory or motor findings

Treatment

  • Correction of Coagulopathy: usually the mainstay of treatment for coagulopathy-related cases
  • Specific Management of Femoral/Lumbar Plexus Compressive Neuropathy
    • Conservative Management
    • Surgical Decompression

References

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